Urinary tract endometriosis: clinical, diagnostic, and therapeutic aspects.
OBJECTIVE
To describe our experience at La Paz University Hospital with 12 patients with urinary tract endometriosis, an uncommon pathologic finding, the most extensive series published by Spanish investigators to our knowledge.


METHODS
We performed a retrospective analysis of 12 cases of urinary tract endometriosis diagnosed from 1993 to 2008.


RESULTS
The mean patient age was 37.75 years. Of the 12 patients, 5 had bladder involvement and 7 had ureteral involvement, 2 bilateral, 2 left, and 3 right. In those with bladder endometriosis, the diagnosis was made by cystoscopy and biopsy in 4 patients. Treatment consisted of laparoscopic hysterectomy and partial cystectomy in 1 patient and exploratory laparotomy, transvesical resection, and transurethral resection of the bladder in 3 patients. One of the patients who underwent transurethral resection of the bladder experienced 2 relapses. The first relapse was treated with transurethral resection of the bladder and the second with laparoscopic partial cystectomy. In the patients with ureteral endometriosis, the diagnosis was mainly established by magnetic resonance imaging. Treatment consisted of ureteroneocystostomy in 5 patients (bilateral in 1) and laparoscopic ureterolysis in 2, with later ureteral resection and end-to-end anastomosis in 1 of them. The patient who underwent bilateral ureteroneocystostomy finally required right autotransplantation because of early ureteral relapses.


CONCLUSIONS
Urinary tract endometriosis is an uncommon pathologic finding. Surgery is the treatment of choice. We believe partial cystectomy should be considered as an initial option in selected cases, depending on the extent and location of lesions. For cases of ureteral endometriosis, the initial technique depends on the location and depth of the lesion.
Pérez-Utrilla Pérez
Manuel
M
Department of Urology, La Paz University Hospital, Madrid, Spain.
Aguilera Bazán
Alfredo
A
Alonso Dorrego
José María
JM
Hernández
Alicia
A
de Francisco
Manuel Girón
MG
Martín Hernández
Mario
M
de Santiago
Javier
J
de la Peña Barthel
Javier
J
D000328:Adult; D004715:Endometriosis / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D014515:Ureteral Diseases / Q000175:diagnosis* / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000175:diagnosis* / Q000601:surgery*